Getting started is easy, keeping the momentum and staying committed is the tough part.

In our multi-part series covering the journey to adopting the ketogenic diet, Dr. David G. Harper has helped us bust ketogenic diet myths, prime our bodies for this lifestyle switch to ensure success, and equip ourselves with tips to alleviate our keto flu symptoms. Once you have conquered the keto flu, what happens next?

From personal experience as a recent convert to the ketogenic diet, I was plagued with many questions of what foods are allowed on the ketogenic diet, when to consume fats and proteins, and whether I should be exercising given the energy slump from cutting out carbs.

It’s important to navigate these questions with the help of an expert on the topic instead of aimlessly searching online, where a multitude of casual commenters add to the confusion. We have the pleasure of inviting Dr. David G. Harper, Co-author of the BioDiet: The Scientifically Proven, Ketogenic Way to Lose Weight and Improve Your Health, to share his insights on how to stay the course towards achieving this important lifestyle change.

DH: Dr. David G. Harper

Assuming we have conquered the keto flu, how do we know when our body has achieved nutritional ketosis?

DH: The first and perhaps most obvious indication of nutritional ketosis is weight loss. Although some of this can be attributed to water loss as a result of the initial diuretic effect, you should also start to notice a reduction of fat, particularly around the mid-section. This reduced waist size is more important than overall weight loss because it targets those areas where fat deposits pose the greatest health risk: what we call visceral adiposity.

If you’re looking for a precise measurement of nutritional ketosis you can use a breath or blood monitor to determine your blood ketone levels. We discuss the pros and cons of these devices in BioDiet, but for most people a tape measurement of your waist in an easy and inexpensive way to determine if you’re in nutritional ketosis. Ketostix aren’t that useful at this point because you’ll be metabolizing the ketones you produce so they shouldn’t show up in your urine in an appreciable amount.

In our previous article talking about Things to Know Before Starting the Ketogenic Diet, we mentioned priming our bodies with MCT Oil to get our bodies adapted to burning ketones as a fuel source. Once we have achieved ketosis, should we still be using MCT Oil in our regimen?

DH: MCT (medium-chain triglyceride) oil is a good way to get your body accustomed to elevated ketone levels, but it does come with some temporary side effects in some people, typically a digestive urgency. If you’re continuing to experience those, I’d suggest reducing the amount of MCT oil consumed or take a break from it altogether.

For those who aren’t experiencing any adverse side effects, you may want to continue on with the MCT oil because it’s kind of a “super-fuel” for the brain, in particular. Recent studies have shown cognitive benefits for those with mild impairment and even for those with Alzheimer’s disease. In addition, when MCT oil is metabolized in the brain it produces less oxidative stress than the alternate fuel - blood glucose - and, therefore, results in less inflammation.

Staying super hydrated was one of the key pointers to alleviating keto flu symptoms, but once our bodies have adjusted, should we still be drinking extra water?

DH: Staying well-hydrated – I call it super-hydration - continues to be a key part of the BioDiet no matter where you are in your journey. Good hydration is important for optimal performance, both physical and cognitive. It also helps prevent headaches and muscle cramps and optimizes kidney function. Also, when you’re not sufficiently hydrated your metabolism slows, which reduces your body’s ability to burn calories. Eight years into the BioDiet, I still start my day with a couple of glasses of water first thing, which wakes up my body and gets my brain going.

Though exercise is always a good addition to a healthy routine, it’s not recommended while you are going through the sluggish Keto Flu phase as it creates extra energy exertion on your body which is still getting used to the significantly lower carbohydrate intake. When should we begin to introduce exercising into our routine again?

DH: I do suggest sticking to light exercise like walking and stretching while your body transitions to burning fat, but once you’ve converted to nutritional ketosis you’ll likely find that you have lots of energy for a more rigorous exercise regime.

Aerobic exercise including running, biking, and swimming will help reduce high blood pressure and strengthen your immune system, while anaerobic exercise like weight-lifting and resistance training will help protect your joints and boost metabolism.

Exercising regularly will not only improve your ability to stay in nutritional ketosis, it will also help maintain bone density, stabilize your mood, and improve your brain health. Plus, exercise makes for a better night’s sleep, which in turn helps with weight loss, because not getting enough sleep raises blood-sugar levels interfering with metabolism and the mobilization of fat.

On a ketogenic diet, we need to replenish the salts we lose as we transition our metabolism. There are a plethora of supplements available for this purpose, and many have added more ‘commercialized’ ingredients to make the products more marketable (such as raspberry ketones, amino acids, ginseng, etc.) Are there any specific ingredients we should avoid?

DH: I believe in eating real food, but many of us who are knowledgeable about nutrition still recommend supplements and take them ourselves. In addition to the salts (sodium, calcium, magnesium, and potassium), I suggest people take the essential fatty acid, omega-3, especially when it’s derived from fish oil. In a healthy diet, the ratio of omega-6, which is pro-inflammatory, to omega-3, an anti-inflammatory, should be about 2:1, but the standard western diet contains about 20 times or more the recommended amount of omega-6. Much of that comes from seed oils, which is why I suggest avoiding them whenever possible. And, since only about one-third of people get sufficient vitamin D, I recommend that as well, especially for those of us in northern climes in the winter when we don’t get sufficient sunlight exposure. I don’t comment on any particular brands, but there are lots of options. Often generic brands are the least costly, yet equally effective.

The ketogenic diet requires a thorough restock of our kitchen to ensure we stay committed to the new lifestyle. What are some top recommended foods to ensure we are adhering to the low carb, high fat, and moderate protein diet?

DH: Great question. There are many social and cultural aspects to diet as well and that can make it tough to stay committed to the BioDiet (think Christmas, weddings, etc.). While you are working through the steps I’ve outlined in the book, it’s best to remove tempting comfort foods that might get you off track. When you re-stock, buy real foods, especially from high quality and, if possible, known sources (e.g. the local farms). One of my favorites is butter from grass-fed cows. It’s full of goodness, very tasty, and high in beneficial omega-3 fatty acids. I also prefer ethically raised animal foods, like free-range chicken and organic beef and other meats. And you should be consuming lots of tasty, fresh vegetables as well, just no beans (except string beans), grains, or high-carb vegetables. There’s a shopping list free to download in the Resources section of our BioDiet website.

*Love your root vegetables like beets, carrots, and potatoes? It’s recommended you avoid starchy and high carbohydrate vegetables on the ketogenic diet*

Some may think that all vegetables and fruits can be a part of the ketogenic diet, but are there some that we may want to avoid?

DH: It’s true that not all fruits and vegetables are equal on the BioDiet. When it comes to vegetables, for example, a good rule of thumb is that if it grows below the ground it’s probably high in starch. This includes carrots, beets, yams, potatoes, etc., which is why these vegetables taste sweet when cooked, as the starch breaks down to sugars.

Most fruits also contain a lot of sugar and, in fact, are selectively bred to be especially sweet. This includes bananas, grapes, pears, apples, and watermelon. So instead of loading up on fruits unnaturally high in fructose, a known metabolic poison, choose berries, including blackberries, strawberries, raspberries, and blueberries, which contain less sugar, more fiber, and are loaded with beneficial phytochemicals. I eat a handful of berries every day. If you are going to consume sweet fruits, consider it like candy; a small slice goes a long way.

You’ll find a glycemic index of fruits and vegetables at biodiet.org under the Resources tab.

The ketogenic diet actually encourages the consumption of indulgent foods like cheese, butter, meats, and more. At first glance, this may seem like it could cause our calorie intake to spike. Should this be a concern and should we be counting calories?

DH: Indulge away! I’d love it if folks indulged in high-fat foods instead of the high-carbohydrate foods that the processed food industry tempts us with relentlessly. You don’t need to count calories on the BioDiet. I recommend that you just eat when you’re hungry and stop when you’re full. And you can actually eat more calories AND lose weight. That’s because people that are keto-adapted have a higher metabolic output (about 250 Kcal/day). The familiar concept of calories-in vs. calories-out has now been largely discarded and we focus on the quality of macronutrients, not quantity. And if you’re worried about dietary cholesterol and saturated fat causing heart disease, there is no robust science to support that hypothesis.

*Foods high in fat are encouraged on the ketogenic diet, including fatty meats and cheeses. Indulge away!*

How should we regulate our meals each day to optimize our daily performance on the ketogenic diet? (Notes: Energy levels usually slump by midday due to lower carb intake, and should we be eating a big breakfast or lunch to kickstart the day?)

DH: That’s an important question. When you eat can be as important as what you eat. Some people like to eat breakfast, while others prefer to wait until later for their first meal. Many people are having great success with intermittent fasting, and/or OMAD (one-meal-a-day), but I’ll focus here on those who generally eat three meals a day.

We are more insulin sensitive first thing in the day so, if you are going to consume carbohydrates, for example, a handful of berries, the morning is the best time to do it. In general, we should eat more calories earlier in the day, say lunchtime, than in the evening. It’s best to refrain from any food within about two hours of turning in for the night. That helps to maximize growth hormone release. About 80% of the growth hormone you release is during your first sleep cycle and you optimize its benefits by going to bed with a less than full stomach. Eating carbohydrates before going to sleep inhibits growth hormone release. There are also optimal times to eat with respect to the type and duration of exercise, and you’ll find more about that in BioDiet.

We want to thank Dr. David G. Harper for again sharing his valuable expertise with our readers to assist us in attaining a healthy diet and staying committed to the ketogenic lifestyle change.

If you are considering the ketogenic diet, the book BioDiet is an excellent resource to accompany your journey as you make the switch. With in-depth guides to the types of food you should consume, and detailed schedules on when to consume different foods throughout the day to achieve a well-formulated ketogenic diet, it sets you up for success. Weight loss is just the first and most visible benefit of the ketogenic diet, and it is important to stay committed to this lifestyle change to experience the long-term benefits, which is a healthier you operating at optimal performance levels in both body and mind.

BioDiet is available in softcover at your local bookstore or online at Amazon, Indigo and Barnes and Noble. It’s also available as an eBook and Audiobook.

ABOUT DR. DAVID G HARPER

As an educator, researcher and health consultant, Dr. David G. Harper, has studied the impact of diet on human health for many years. The culmination of that extensive work is the BioDiet, a well-formulated ketogenic plan that works with the body’s natural processes to improve health and reverse decades of damage caused by our collective carbohydrate addiction.Dr. Harper and Dale Drewery adopted the BioDiet in 2012 and the weight loss and health improvements they experienced led him to counsel hundreds of people on the Biodiet with similarly consistent and impressive results.

Dr. Harper is an associate professor of kinesiology at the University of the Fraser Valley and a visiting scientist at the BC Cancer Research Center, Terry Fox Laboratory. He holds a PhD from the University of British Columbia and completed a post-doctoral fellowship in comparative physiology at the University of Cambridge. He is on the scientific advisory board of the Canadian Clinicians for Therapeutic Nutrition and is a member of the Institute for Personalized Therapeutic Nutrition.